Self-Reported Disadvantage in Medical School Admissions: A Call to Review, Revise, and Further Advance Holistic Review.

PURPOSE: This study examined how applicants interpret the self-reported disadvantaged (SRD) question in the American Medical College Application Service (AMCAS) application. METHOD: Data from 129,262 applicants who applied through AMCAS from 2017 through 2019 were used, including financial and family history, demographic characteristics, and work status and residence. Fifteen applicants from the 2020 and 2021 AMCAS cycles were interviewed about their experiences with the SRD question. RESULTS: Large effects were found for SRD applicants with fee assistance waivers ( h = 0.89), Pell grants ( h = 1.21), state or federal aid ( h = 1.10), and parents with less education ( h = 0.98) and non-SRD applicants with a large proportion of their education paid by family ( d = 1.03). Another large difference was found for reported family income distribution (73% of SRD applicants reporting family income < $50,000 vs 15% of non-SRD applicants). More SRD applicants were Black or Hispanic (26% vs 16% and 5% vs 5%), Deferred Action for Childhood Arrivals recipients (11% vs 2%), born outside the United States (32% vs 16%), and raised in a medically underserved area (60% vs 14%). There was a moderate effect for first-generation to college SRD applicants ( h = 0.61). SRD applicants had lower Medical College Admission Test scores ( d = 0.62) and overall and science grade point averages ( d = 0.50 and 0.49, respectively) but no meaningful differences in acceptance or matriculation rates. The interviews identified 5 themes: (1) unclear disadvantage definition; (2) different perceptions of disadvantage and overcoming challenges or obstacles ; (3) identification as disadvantaged or not; (4) SRD essay content; and (5) concerns about lack of transparency in how the SRD question is used in admissions. CONCLUSIONS: Revising the SRD question by including context, phrasing, and instructions for broader experience categories might be beneficial because of lack of transparency and understanding.

The Diversity and Success of Medical School Applicants With Scores in the Middle Third of the MCAT Score Scale.

Admissions officers assemble classes of medical students with different backgrounds and experiences who can contribute to their institutions' service, leadership, and research goals. While schools' local interests vary, they share a common goal: meeting the health needs of an increasingly diverse population. Despite the well-known benefits of diversity, the physician workforce does not yet reflect the nation's diversity by socioeconomic status, race/ethnicity, or other background characteristics.The authors reviewed the Medical College Admission Test (MCAT) scores and backgrounds of 2017 applicants, accepted applicants, and matriculants to U.S. MD-granting schools to explore avenues for increasing medical school class diversity. They found that schools that accepted more applicants with midrange MCAT scores had more diverse matriculating classes. Many schools admitting the most applicants with scores in the middle of the MCAT score scale were public, community-based, and primary care-focused institutions; those admitting the fewest of these applicants tended to be research-focused institutions and to report pressure to accept applicants with high MCAT scores to maintain or improve their national rankings.The authors argue that reexamining the use of MCAT scores in admissions provides an opportunity to diversify the physician workforce. Despite evidence that most students with midrange MCAT scores succeed in medical school, there is a tendency to overlook these applicants in favor of those with higher scores. To improve the health of all, the authors call for admitting more students with midrange MCAT scores and studying the learning environments that enable students with a wide range of MCAT scores to thrive.

Recruiting American Indian/Alaska Native Students to Medical School: A Multi-Institutional Alliance in the U.S. Southwest.

PROBLEM: Despite national efforts to diversify the physician workforce, American Indian/Alaska Native (AI/AN) individuals have the least representation of all major racial and ethnic groups. Limited resources at state medical schools present institution-level recruitment challenges. Unified efforts to engage AI/AN students in premedical education activities are needed. APPROACH: The medical schools at the Universities of Arizona (Phoenix and Tucson), Colorado, New Mexico, and Utah identified a collective need to increase student diversity, particularly with regard to AI/AN students. The schools partnered with the Association of American Indian Physicians to support AI/AN students applying to medical school and to grow the overall AI/AN applicant pool. Each year from 2011 to 2016, these institutions hosted a two-day preadmissions workshop (PAW) to prepare participants for applying to medical school. OUTCOMES: From 2011 to 2016, 130 AI/AN students participated in the PAWs. Of these, 113 were first-time attendees, 15 participated on two separate occasions, and 1 participated on three separate occasions. Nineteen (21%) of the 90 first-time participants from 2011 to 2015 matriculated to a U.S. medical school in the past five years. Twenty-two of 23 participants (96% response rate) in 2016 responded to the postworkshop survey. Results indicated that interview preparation, individual consultation, and writing preparation ranked as the three most beneficial sessions/activities. NEXT STEPS: Standardized evaluation of future PAWs will identify best practices for recruiting AI/AN students to medical school, and future initiatives will include more robust measures of success.